Seminar: Medical Assistance and Long-term Care

Stuart E. Schmitz and Jeffrey Schmidt
Schmitz, Schmidt & Anderson, PA.
400 Robert Street North, #1840
St. Paul, Minnesota 55101
651-291-2405

Long Term Care Payment Sources

  • Medicare
  • Health Insurance
  • Long Term Care Insurance
  • Veterans Benefits
  • Private Payment
  • Medical Assistance

Medical Assistance (Title 42 United States Code, section 1396a, and Minnesota Statutes, Chapter 256B)

  • State/Federal program to fund health care costs of poor, disabled and elderly (“Medicaid” in many states)
  • Eligibility
  • Three requirements (Residency/Categorical/Financial)
    • Asset Limit = $3,000.00
    • “Available” Assets
    • “Unavailable” Assets
  • “Exempt” Assets
  • Homestead
  • Income Contribution Toward Care = All Except $97.00 Per Month Personal Needs Allowance

Asset Protection of “Community Spouse” — The Community Spouse Resource Allowance (CSRA)

  • Assets assessed as of first date of a continuous period of institutionalization of 30 days or more
    • First continuous period of institutionalization
    • Asset Assessment form and verifications
  • Assets are allocated (but not necessary transferred) between the spouses as shown in Figures A, B and C

Figure A

Institutionalized Spouse

Assets at Institutionalization
$100,000

Community Spouse

$50,000

“Spend Down”

$50,000

($47,000)

Assets remaining at application date

0

$3,000

$53,000

$50,000

Figure B

Institutionalized Spouse

Assets at Institutionalization
$250,000

Community Spouse
(maximum share)

$130,780

“Spend Down”

$119,220

($127,780)

Assets remaining at application date

0

$3,000

$122,220

$119,220

Figure C

Institutionalized Spouse

Assets at Institutionalization
$40,000

Community Spouse
(mimimum share)

$6,149

“Spend Down”

$33,851

($3,149)

Assets remaining at application date

0

$3,000

$36,851

$33,851

Income Protection of “Community Spouse”

  • Community spouse keeps all of his or her own income
  • Community spouse assured monthly income of $1,967 (the Minimum Monthly Maintenance Needs Allowance or MMMNA)
  • The MMMNA is raised by the amount that “shelter expenses” exceed $590 each month, up to a cap of $2,980.50
  • Community spouse may be allowed to retain an allocation of the institutionalized spouse’s income as described in Figure D below
  • Community spouse may be allowed to retain more assets (over an above the CSRA) if the combined income is too small to meet the MMMNA

Figure D

Minimum monthly maintenance needs allowance

$1,967
Shelter Expenses = Mortgage, Insurance, Taxes, Utility
Standard of $450

$690
“Excess” Shelter Expenses = Amount over $590

$100
Community Spouse Monthly Maintenance Needs Allowance

$2,067
Community Monthly Spouse Income

$1,000
Income Allocation from Institutionalize Spouse

$1,067
Community Spouse Income

$2,067

Transfers of Assets

  • A “Period of Ineligibility” is imposed with transfers for less than fair market value
  • All transfers must be disclosed at the time of Medical Assistance application
  • Look-back = 60 months immediately before the month of application
  • Period of Ineligibility begins with the month after an application where the individual is proved to be otherwise eligible
  • Determining the period of ineligibility for transfers:

Amount
Transferred

Statewide average payment rate
for skilled nursing facility care
($5,660 as of July 2014)

Period of Ineligibility

$10,000

$5,660

 1.77 months beginning in the month after application

$50,000

$5,660

 8.83 months beginning in the month after application

$100,000

$5,660

 17.67 months beginning in the month after application

$400,000

$5,660

 70.67 months beginning in the month after application. (Could be limited to 60 months with the “look back” rule.)

Liens and Estate Recovery

  • Liens Against Non-Homestead Real Estate – Satisfied Only When Sold
  • Claim Against Estate of Second Spouse to Die to Reimburse Benefits Paid

Home and Community-Based Long-Term Care Programs

  • Elderly Waiver – Medical Assistance eligibility
  • Alternative Care – State funded, retain more assets
  • Group Residential Housing – Assisted Living Facility Assistance

©Schmitz, Schmidt & Anderson, P.A. 2014